Measure ID: MIPS 415|Emergency Medicine|2026 Performance Year

2026 MIPS Measure #415: Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt

Percentage of emergency department visits for patients aged 18 years and older who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider who have an indication for a head CT.

Efficiency – High PriorityEmergency MedicineImaging
Measure ID:MIPS 415 (Quality ID 415)
Collection:MIPS CQM
Topped Out:Yes
View CMS Spec ↗

Measure Specification

Eligible Population
Patients aged ≥ 18 years on date of encounter
ANDDiagnosis for minor blunt head trauma
ANDPatient encounter during the performance period
WITHOUTEncounters conducted via telehealth: M1426
ANDPatient presented with a minor blunt head trauma and had a head CT ordered for trauma by an emergency care provider: G9530
Exclusions
G9531Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar
Numerator
Emergency department visits for patients who have an indication for a head CT.
Reporting Codes

Performance Met:

G9529Patient with minor blunt head trauma had an appropriate indication(s) for a head CT

Performance Not Met:

G9533Patient with minor blunt head trauma did not have an appropriate indication(s) for a head CT
VBCA Insights

Why This Measure Matters

Many ED visits for minor blunt head trauma result in head CT scans that aren't indicated by injury severity, mechanism, or symptoms. This measure promotes appropriate imaging using validated criteria (e.g., requiring specific red flags like loss of consciousness). Low rates mean your ED team is using evidence-based decision rules to avoid unnecessary radiation in low-risk patients. Education and protocols reduce CT overuse, lower patient radiation exposure, and lower costs while maintaining patient safety.

VBCA is a CMS-approved Qualified Clinical Data Registry (QCDR) that submits MIPS Measure 415 to the Quality Payment Program (QPP). Practices can report this measure as a MIPS Clinical Quality Measure (CQM) or through qualified registry submission.

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Specialty Measure Sets

Emergency Medicine

Clinical Rationale

Though it is difficult to directly attribute the effects of smaller dosages of radiation, such as that received through computed tomography (CT), the dosage of radiation from CTs has increased in recent years, in part due to the increased speed of image acquisition. Additionally, there is evidence to suggest that the radiation doses from CTs are higher and more variable than generally quoted.

Further, as “radiation doses associated with commonly used CT examinations resemble doses received by individuals in whom an increased risk of cancer was documented,” the use of some CT scans is associated with a “nonnegligible” lifetime attributable risk of cancer. As over 1.3 million individuals are treated and released from the ED for mild traumatic brain injury annually, it is critical that CT scans only be utilized when clinically appropriate.

Through measurement of the share of CT scans that are performed inappropriately, a focus can be brought to quality improvement and increased application of clinical decision tools around this topic.

Clinical Recommendations

The following evidence statements are quoted verbatim from the referenced clinical guidelines and other references: A noncontrast head CT is indicated in head trauma patients with loss of consciousness or posttraumatic amnesia only if one or more of the following is present: headache, vomiting, age greater than 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicle, posttraumatic seizure, GCS score less than 15, focal neurologic deficit, or coagulopathy.

(Level A recommendation) (American College of Emergency Physicians (ACEP), 2008). A noncontrast head CT should be considered in head trauma patients with no loss of consciousness or posttraumatic amnesia if there is a focal neurologic deficit, vomiting, severe headache, age 65 years or greater, physical signs of a basilar skull fracture, GCS score less than 15, coagulopathy, or a dangerous mechanism of injury.

[Dangerous mechanism of injury includes ejection from a motor vehicle, a pedestrian struck, and a fall from a height of more than 3 feet or 5 stairs.] (Level B recommendation) (American College of Emergency Physicians (ACEP), 2008) Based on the recommendations, patients age ≥ 65 are always considered high risk according to the Canadian CT head injury rule.

The New Orleans Rule, on the other hand, uses an age cutoff of 60. It categorizes patients aged 60+ as high risk under certain circumstances (LOC or amnesia/disorientation). This leads to a situation where patients age 60-64 are categorized differently because of idiosyncrasies in how the Canadian and New Orleans studies were designed, and the measure appropriately incorporates these rules into its design.

Implementation Notes

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation of this measure, this visit measure is submitted each time a patient is seen by the individual MIPS eligible clinician during the performance period.

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